1Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Iran2School of Nursing and Midwifery, Tehran University of Medical Sciences, Iran3Department of biostatics and epidemiology, Kashan University of Medical Science, Iran4Department of Surgical Technology, Kashan University of Medical Sciences, Iran

Abstract

Marital satisfaction as an important aspect of marital quality has a significant role in family functioning. This study was conducted to evaluate the levels of marital satisfaction and its related factors among older. A cross-sectional study was carried out on a sample of 400 hospitalized older adults. The cluster sampling method was applied for choosing participants. The Farsi Enrich questionnaire was used for gathering data. Data were analyzed using the Chi-square test, t-test, ANOVA and binary logistic regression at the multivariate model.

Among the respondents, 40.6% were females, 69.8% were Illiterate and 14.7% had a Physical disorder. The mean age of the participants was 65.2 ±5.7 years. The mean overall marital satisfaction scores in the men and women of older adults were 110.91±9.78 and 109.70 ±10.56, respectively. Marital satisfaction no had significant relationship with gender. In univariate analysis, significant difference was observed among marital satisfaction with level of education and remarriage (P<0. 05). A significant correlation was found between length of marriage and marital satisfaction scores (r=0.30, P=0.001). In multivariate analysis, the variables of gender, remarriage and having physical disorders stayed in the model that had a statistical relationship with the marital satisfaction (p<0/05). It could be inferred that older adult have undoubtedly better feeling about their marital life that cause to effective discussion for understanding each other.

Introduction

In spite of widely studies about marital satisfaction, many researchers have claimed that some aspects still need to be explained. Marital satisfaction as an important aspect of marital quality [1] has significant role in family functioning that means people’s perception of their marital relationship [2] or the satisfaction that is experienced by couples [3]. Undeniably, marital satisfaction occurs over time due to the need for identifying personality traits, communication and behavioral patterns and adapting couple’s preferences [4]. What is more, marital satisfaction has evidently been effective on almost all aspects of life which cause to improving family functioning, facilitate parent’s role as well as increased health and longevity and finally increased life satisfaction [5]. Hence, what it can be said is the undeniable role of marital satisfaction in family health [6]. Moreover, Pleasant and relaxing couple's relationship is not only suitable in order to their growth and flourishing, but also it is essential for children’s development and growth [7]. So, it could be definitely considered as a factor for achieving life’s goals and is effectively influenced mental disorders in the community [8]. Although, results of a study shows that almost all couples have high marital satisfaction in early years of marriage life but, it painfully decreases over time when their age increases [9]. On the other hand, lack of marital satisfaction has important consequences such as impairment in social interaction, feelings of isolation and loneliness, lower life satisfaction and family disputes that note the importance of this factor again [10].

Results of some studies have shown that factors such as social, economic (income) and employment situation as well as personality, cognitive, religious factors besides, dating before marriage, spousal age, number of children, couples’ age gap, addiction, education, gender, disease and sexual satisfaction involved in marital satisfaction [2,5,11-13]. It is worth to mention that Chiung and et al have claimed that factors affecting marital relationship is obviously vary in different culture [14]. The most marital dissatisfaction is related to women [15] and in another study has been reported that marital satisfaction in women increases with age [11]. Nevertheless, Amato asserted that marital happiness have been equal among men and women [16]. besides, the results of some studies show satisfaction about sexual activity is one of the most important factors affecting marital satisfaction, so lower satisfaction will occurs when sexual activity reduce due to aging [4,10,11,14,15].

Additionally, having low levels of education in large percentage of adults has been shown through a study could cause to lower level of satisfaction [4], since high education levels leads to better communication and conflict resolution skills in marriage [2]. In spite of this results, a few studies have been conducted about elderly people in Iran have shown inconsistent results. Considering the growing elderly population in our society, this study aimed to examine the marital satisfaction and the associated demographic factors in Kashan city.

Methodology

This cross-sectional study was conducted on 400 older adults covered through health centers of Kashan. Then, the samples were selected by cluster sampling method after receiving ethical approval from the ethics committee. Kashan has 30 health centres that 8 centres were randomly selected among them and sample were randomly selected from the list of persons registered in each centre. Next, going to their homes, questionnaires were completed by the interviewer. Inclusion criteria include aged 65 and older, having living spouse, no mental illness, and independence in daily activities, Iranian nationality for both spouse, ability to answer questions and finally, their tendency to participate in the study. In addition, a two parts - questionnaires includes demographic (age, gender, education, number of children, employment, length of marriage, smoking history) and Enrich questionnaire (Marital satisfaction questionnaire) were applied for collecting data.

Enrich questionnaire has been designed by Elson in 1989 for the first time in order to measuring marital communication which includes some sub-scales such as ideal distort (5 questions), sexual satisfaction (10 questions), communication (10 questions) and Conflict Resolution (10 questions). Validity and reliability of this questionnaire has been measured In Iran several times. Sub-scales reliability was measured by Cronbach's alphas coefficient which appropriate rate was gained (from 0.80 to 0.92) [17]. Identically, in current study questionnaire reliability was measured by Cronbach's alphas coefficient and a group of 10 elderly people was considered as population who were assessed after 10 day again for examining questionnaire reliability. The Correlation coefficient is equal to 0.91. Commonly, SPSS 16 software was applied for analysis the data gathered during the research. At the first stage, Data were tested through T- test and ANOVA and then the variables by P≤2 were selected for logistic regression model.

Findings

Among the respondents, 40.6% were females, 69.8% were Illiterate and 14.7% had a Physical disorder. The mean age of the participants was 65.2±5.7 years. Demographic and clinical characteristic of older adults is stated in Table 1. Four hundred older adults with an average age of 65.2±5.7 participated in this study. The average of total score of marital satisfaction of the older adults was 107.89±12.3 and 222 subjects (55.5%) had a high marital satisfaction. The mean score marital satisfaction was 110.9 (9.8) in men with and 109.7 (10.6) in women. No significant difference was observed between male and female older adults. The comparison of dimensions of marital satisfaction among older adult showed that mean dimension of sexual satisfaction score was significantly different with gender. However, the mean communication, conflict resolution and ideal distort scores were not significantly different among male and female of older adults Table 2.

Qualitative Variables

Number

(%)

Gender

Women

159

(40.6)

Men

241

(59.4)

Smoking

Yes

88

(22.4)

No

312

(77.6)

Job

Self- employed

151

(37.8)

governmental

112

(28)

Housekeeper

113

(28.2)

Worker

24

(6)

Education

Illiterate

274

(69.8)

Literate

126

(30.2)

Physical Disorder

yes

59

(14.7)

No

341

(85.3)

Quantitative Variable

mean±SD

Rang

Age

65.2±5.7

60-87

Length of Marriage

41.7± 5.9

24-70

Number of Children

4±1.6

0-9

Total

400

(100)

Table 1: Demographic characteristics of older adults in the study.

Dimensions of Marital Satisfaction

Gender

Mean & Sd

Scores (percentage)

P

Sexual Satisfaction

women

31.35 ± 4.76

62/7

0/003

men

33.56 ± 5.03

67/1

Communication

women

31.42 ± 4.21

62/8

0/21

men

30.73 ± 3.45

61/4

Conflict Resolution

women

30.61 ± 3.46

62/1

0/07

men

29.67 ± 3.57

59/3

Ideal Distort

women

16.30 ± 2.58

65/2

0/07

men

17.01 ± 2.54

68

Total Score

women

109.70 ± 10.56

62/7

0/38

men

110.91 ± 9.78

63/4

Total Score

400

107.89 ± 12.3

62

Table 2: The Comparison of average marital satisfaction among elderly men and women.

In unvariate analysis, significant difference was observed among marital satisfaction and Remarriage (P < 0.01) and literacy level (P < 0.05). However, gender, job, Physical disorder and Smoking did not have significant relationship with marital satisfaction Table 3. The mean length of marriage score was 41.7±5.9. The A significant correlation was found between length of marriage and total score of marital satisfaction (r=0.30, P=0.001). No significant correlation was observed between age and number of children and total score of marital satisfaction.

The Regression logistic with backward stepwise method was used for the multivariate analysis. The variables of gender (OR = 2.9), job (OR = 0.119), Remarriage (OR = 0.311) and having Physical disorder (OR=0.237) stayed in the model that had a statistical relationship with the marital satisfaction. On the other hand, the marital satisfaction of men older adults was better than women. The individuals who had no remarriage had more marital satisfaction. Also having Physical disorder was result in decrease of marital satisfaction Table 4.

Discussion

The result shows that elderly people have undoubtedly better feeling about their marital life that cause to effective discussion for understanding each other [17]. It seems that couples who have more leisure time and hobbies in common, have more emotional and verbal communications, which cause to improving physical and mental health and increasing their self- satisfaction and marital satisfaction [7]. Couples, who are satisfied with their marriage, consider marital relations as a supportive relationship [12]. In our traditional and religious society, due to the social and religious participation in family routines activity, there is greater understanding between family members. It could be considered because of religious beliefs which cause to controlling anger and considering the God when anger Occurs. Thus, it seems that conflict between couples is prevented as a result of religious beliefs. The results show that although marital satisfaction in the elderly couples was similar in univarate analysis, but after removing the confounding effect these differences was significant. However, the multivariate analysis showed that marital satisfaction was higher in men than women. The reason can be attributed to the higher expectations of women rather men. In addition, feelings about relationships or marital satisfaction are not easily expressed in our society by women.

Results of Guo & Huang [12] also showed that the mean of marital satisfaction score was higher in men than women and. In contrast to these results, Amato is expressed that satisfaction and happiness were similarly equal in men and women [16]. In another point of view, the results of Bakhshi et al. & King et al. have shown that marital satisfaction in women is positively associated with aging. To be more precise, one of the most influential factors affecting marital satisfaction is sexual satisfaction. Additionally, aging causes disturbances in sexual function and activity [15,18-20]. So, couples expectations and demands changes and mutual attraction reduces [18]. Alphonse and Jose also considered age as a factor involving to sexual adaptation [21]. For explaining the contradictory findings, it can be argued that it is probably due to the differences between age groups of the samples in different studies. In addition, according to Bramon study geographical differences affecting common life satisfaction [22]. Thus, in spite of increasing marital satisfaction with age, Satisfaction among men and women are not equal. Therefore, in order to extend the results, geographical and cultural differences must also be considered. Occupation and income was another factor influences on marital satisfaction interacting with other variables in elderly groups.

Most of marital satisfaction has been among housewives, then individuals with governmental occupation, next self-employed people and ultimately workers. This is probably due to the lack of economic stability for self-employed people that decrease marital satisfaction.

The results of Sadegh Moghadam et al. [12] showed that job satisfaction is directly associated with marital satisfaction. Overall, Job insecurity and low income followed by concern about economic problems and lower marital satisfaction. Thus, it seems that sufficient income cases to high levels of marital satisfaction [13]. Vaijayanthimala et al. [23] have suggested that marital satisfaction is influenced by income and employment. Identically, Zainah et al. [1] & Trudel [24], and Chou have also shown that high income increases marital satisfaction which is consistently associated with the result of current study. Similarly, the result of another study indicated that mental health of husbands, who their wives are not housewives, is more than others. So, it seems that Women's employment, if that would not conflict with their roles as wives, have a positive impact on their husbands, children and also their social interactions [13]. In addition, due to the social interactions of being employed and also their friends and social relationships, marital satisfaction increases.

The results of the present study have shown that remarriage decreases marital satisfaction. In other words, People who remarried were less satisfied with their marriages than those who did not remarry. Ahmadi et al. [3] also emphasized on this issue in their study [4]. But the results of Bograd et al. [25] study are inconsistent with this conclusion.

In explaining these findings, it can be said that the people with marital problems in their first marriage will experience similar problems in subsequent ones which cause to lower marital satisfaction rather first marriage. To put it simply, instability of first marital caused instability in the subsequent marriage [2,16,26].

The results of this study showed that there was no relationship between overall satisfactions of marriage and education. The reason probably is the low educational level of elderly participants (both sexes) in this study. It can be added that studies have shown that increasing the education level of the couples cause to understanding each other more, which in turn may increase their marital satisfaction [11,12,27,28]. Thus, High education level could undoubtedly improve communication and conflict resolution skills between couples. It also can improve the economic situation of families. As a consequence, pressure of economic problems is reduced and consequently marital satisfaction will improve [2].

Number of children was the other demographic variables were examined in this study. According to results of this study, there was no relationship between overall marital satisfaction and the number of children. Nevertheless, Edwards and White [24] were stated that no children are positively correlated with marital satisfaction [1]. Also, number of children has been considered a factor in marital satisfaction by Guo & Huang [11].

Bakhshi et al. [10] also have mentioned to children as a factor involved in marital satisfaction. Blumel concluded that child care (two or more) increases quality of life [29]. In another study it was stated that the number of children is associated with sexual compatibility (34) and having children is cause to stability of marriage [30].

Since having children is one of the young couple's life goals [31], therefore, the number of children in old age has no significant impact on marital satisfaction.

On the other hand, other studies about different culture and also different age have reported that factors affecting marital relationship is obviously vary in different culture. All in all, it is suggested that more investigations needs to be applied in order toreliable Results. Oddly enough, there was no relationship between marital satisfaction lengths of marriage presumably because of high average of marriage length about all elderly people in this study that contributes to marital satisfaction. It is claimed that as a result of achieving compatibility over time, couples experience less conflict and stress [1].

So, as Jose and Alfons have stated lengths of marriage is related to marital satisfaction; however, in this study due to the high average of marriage length about all elderly people there was no relationship between marital satisfaction lengths of marriage. While there was no relationship between marital satisfaction and smoking in this study, Himish et al. [32] have reported that smoking or alcohol consumption decreases marital satisfaction [33]. Additionally, negative relationship between marital satisfaction and smoking has been reported [34]. In relation with this issue, Addis et al have assessed that sexual satisfaction in women who were not smoke is more than other [35]. Because of the small number of participants in this study reported a history of smoking and none of them were currently smoking and drugs, there was no relationship between smoking and overall marital satisfaction [36].

Conclusion

Considering current study has been compared the marital satisfaction in elderly men and women, showed that older people were in the high satisfaction range. Due to this study was conducted in a traditional and religious society which contributes to marital satisfaction, this result was not unexpected. In addition, lower marital satisfaction in women rather than men is related to higher women's expectations than men or more women’s restrictions in traditional societies that cause to isolation and lack of women’s comfort, especially about sexual matters with their spouses. Therefore, it is recommended to educate and raise awareness of women's culture in order to obtain self-express and also self esteem.